Displaced pelvic fracture is among the most complicated fractures in traumatic orthopedics, with high mortality and morbidity. Reduction is considered a complex procedure as well as a key part in surgical treatment. However, few robotic techniques have been employed in the reduction of pelvic fracture, despite the rapid advancement of technologies. Recently, we designed a robot surgery system specialized in the autonomous reduction of displaced pelvic fracture and applied it in the true patient for the first time. In this paper, we report its successful clinical debut in the surgery of a displaced pelvic fracture. Total surgery time was 110 min and an anatomic reduction was achieved. We then present a brief overview of the literature about reduction techniques in pelvic fracture and introduce related principles involved in our robot-assisted reduction system.

Objective: The prognostic nutritional index (PNI) has been reported as a significant predictor in various diseases. However, the prognostic value of the PNI in geriatric hip fracture patients has not been thoroughly evaluated. This study aimed to investigate the association between admission PNI and 3‐year mortality in those patients.Methods: In this post hoc analysis, we included patients aged ≥65 years who underwent surgery for hip fracture between 2018 and 2019. The admission PNI was calculated as serum albumin (g/L) +5 × total lymphocyte count (×10⁹/L). Patients were categorized into four groups based on PNI quartiles (≤ 43.55, 43.55–46.55, 46.55–49.20, and >49.20, respectively). The median follow‐up duration was 3.1 years. Cox proportional hazards models were used to calculate the hazard ratio (HR). Receiver operating characteristic curve (ROC) was conducted for using PNI to predict mortality.Results: Of the 942 eligible patients, 190 (20.2%) patients died during the follow‐up. Compared to patients in the first quartile (Q1), those in the second (Q2), third (Q3), and fourth (Q4) quartiles had significantly lower mortality risks (HRs 0.50, 95% CI 0.35–0.74; 0.41, 95% CI 0.26–0.64; and 0.26, 95% CI 0.15–0.45, respectively). The optimal cutoff of PNI for predicting mortality was set as 45.275 (sensitivity, 0.674; specificity, 0.692; area under the curve (AUC), 0.727). Patients with higher PNI (>45.275) had a significant lower mortality risk (HR 0.39, 95% CI 0.28–0.55) compared to those with lower PNI (≤ 45.275).Conclusion: PNI is a reliable and independent predictor of 3‐year mortality after hip fracture surgery in the elderly.

Factors related to mortality after osteoporotic hip fracture (HF) have been investigated intensively, except for proximal femoral bone mineral density (BMD), which is also the primary cause of osteoporosis. In this study, we aimed to investigate the association of hip BMD with mortality risk after HF. Four hundred and eleven elderly patients with HF in Beijing, China, were included and prospectively followed up with a median time of 3 years. At baseline, quantitative CT technique (QCT) was used to measure areal BMD (aBMD) of the unaffected hip. Areal BMDs of the total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter were analyzed with postoperative mortality as the primary outcome. A total of 394 patients (78.59 ± 7.59 years, 75.4% female) were included in our final analysis, with 86 (82.23 ± 7.00 years, 81.4% female) dead. All hip bone densities demonstrated a significant association with mortality risks in the unadjusted model, but only TR aBMD remained significantly correlated after adjusting for all covariates. Compared to the lower TR aBMD group, the higher TR aBMD group yielded significantly lower death risks (HR 0.21 95% CI 0.05–0.9,P = 0.036). Higher survival probabilities were observed for higher TH and TR aBMD in survival analysis (P < 0.001). Hip BMD, especially TR BMD assessed by QCT, is an independent risk factor for postoperative mortality following HF. QCT may present a promising avenue for opportunistic analysis in immobilized patients, providing valuable information for early detection and personalized interventions to enhance patient outcomes.

Sarcopenia, a progressive musculoskeletal disorder associated with aging, is characterized by the deterioration of muscle mass, strength, and physical performance. This condition significantly increases the risk of debilitating consequences including functional impairment, diminished life quality, and increased mortality. With the progress of aging, it will affect a large number of people in the world and bring many problems. Despite its clinical significance, there are no medicine used to treatment sarcopenia by FDA approval in clinical. This systematic review synthesizes current evidence on the diagnostic and therapeutic potential of irisin—a myokine induced by exercise—in sarcopenia, aiming to address two key questions: (1) Can irisin serve as a reliable biomarker for sarcopenia diagnosis? (2) Does irisin hold promise as a therapeutic agent for sarcopenia management? A comprehensive literature search was conducted across multiple databases (Web of Science, PubMed, Cochrane Library, and Embase) to examine the relationship between irisin and sarcopenia. Eligible studies meeting our inclusion criteria underwent rigorous quality assessment. 364 studies were identified, of which only 21 met the inclusion criteria—12 involving human studies and 9 involving animal and cell experiments. In human studies, irisin may serve as a potential diagnostic marker for sarcopenia in the elderly and postmenopausal women. In addition, as a myokine of exercise induced, increased circulating levels of irisin may enhanced skeletal muscle mass. Moreover, animal and cellular experiments suggest that increased levels of irisin help improve muscle mass. In conclusion, this review indicates that irisin has potential therapeutic effects for sarcopenia and may become a promising treatment for sarcopenia in the future. However, there is currently a lack of high-quality studies on the use of irisin in treating sarcopenia, and the relevant mechanisms of action are not yet clear. Therefore, more studies are needed to clarify the relationship between irisin and sarcopenia in the future.

Purpose: Kocher-Langenbeck (K-L) approach is widely used in surgery of posterior wall fracture of acetabulum. However, challenges are frequently encountered in fractures involving the superior dome due to its short of view. We aimed to evaluate the efficacy of digastric trochanteric flip osteotomy (DTFO) in the K-L approach for high posterior wall acetabular fracture (HPWF). Methods: From January 2014 to December 2016, 39 patients who suffered high posterior wall fracture (HPWF) were included in this retrospective study. All the patients were divided into two groups according to surgery type (17 standard K-L approach (control group), 22 with DTFO (DTFO group)). The Matta criterion was used to evaluate the accuracy of reduction according to post-operative CT image, while modified Harris hip score and 12-item short-form health survey (SF-12) were applied to measure the clinical outcomes. Results: The median follow-up period was 55 (45 to 62.5) months. Blood loss and operation time were similar between the two groups. DTFO group achieved much more anatomical reduction than the control group (54.6% vs. 35.3%; OR, 2.2; 95% CI, 0.6 ~ 8.08). Significantly better functional outcomes were found in the DTFO group (10% higher points than the control group, p < 0.05). All the patients receiving good-to-anatomical reduction ended with good or excellent outcomes. The total incidence of complications in the DTFO group was much lower than in the control group (40.9% vs. 70.6%, p = 0.07). Conclusions: Compared with the traditional K-L approach, the intraoperative DTFO technique enabled better quality of reduction in patients with HPWF, thus ensuring superior clinical outcomes.

Emerging evidence indicates a complex interplay between skeletal muscle and cognitive function. Despite the known differences between muscle quantity and quality, which can be measured via computed tomography (CT), the precise nature of their associations with cognitive performance remain underexplored. To investigate the links between muscle size and density and cognitive impairment (CI) in the older adults with hip fractures, we conducted a post hoc, cross-sectional analysis within a prospective cohort study on 679 patients with hip fractures over 65. Mini-Mental State Examination (MMSE) and routine hip CT imaging were utilized to assess cognition function and muscle characteristics in older adults with hip fractures. The CT scans provided data on cross-sectional area and attenuation for the gluteus maximus (G.MaxM) and the combined gluteus medius and minimus (G.Med/MinM). Participants were categorized into CI and non-CI groups based on education levels and MMSE scores. Multivariate logistic regressions, propensity score (PS) methods, and subgroup analysis were employed to analyze associations and validate findings. This study included 123 participants (81.6 ± 6.8 years, 74% female) with CI and 556 participants (78.5 ± 7.7 years, 72% female) without. Compared to the non-CI group, muscle parameters, especially density, were significantly lower in the CI group. Specifically, G.Med/Min muscle density, but not size was robustly associated with CI (odds ratio (OR) = 0.77, 95% confidence interval = 0.62–0.96, P = 0.02), independent of other medical situations. Sensitivity analysis corroborated that G.Med/Min muscle density was consistently lower in the CI group than the non-CI group, as evidenced in the PS matched (P = 0.024) and weighted cohort (P = 0.033). Enhanced muscle parameters, particularly muscle density in the G.Med/MinM muscle, correlate with a lower risk of CI. Muscle density demonstrates a stronger association with cognitive performance than muscle size, highlighting its potential as a key focus in future cognitive health research. Recent research reveals a fascinating connection: the state of our muscles may influence our brain's health, particularly in older adults. This study focused on individuals over 65 with hip fractures, examining their muscle size and quality through computed tomography scans and assessing their cognitive function. Interestingly, those with CIs had notably lower muscle density, especially in specific hip muscles, compared to those without impairments. The findings suggest that muscle quality, rather than just size, is crucial for cognitive health as we age. This highlights the importance of maintaining strong and healthy muscles not just for physical well-being, but for our mental sharpness too. It opens new paths for future research on preventing cognitive decline through muscle health.